Upstate Medical University Research Articles

Longitudinal Effects of Combination Antiretroviral Therapy on Cognition and Neuroimaging Biomarkers in Treatment-Naive People With HIV.

While combination antiretroviral therapy (cART) has dramatically increased the life expectancy of people with HIV (PWH), nearly 50% develop HIV-associated neurocognitive disorders. This may be due to previously uncontrolled HIV viral replication, immune activation maintained by residual viral replication or activation from other sources, or cART-associated neurotoxicity. The aim of this study was to determine the effect of cART on cognition and neuroimaging biomarkers in PWH before and after initiation of cART compared with that in HIV-negative controls (HCs) and HIV elite controllers (ECs) who remain untreated. We recruited 3 groups of participants from the University of Rochester, McGovern Medical School, and SUNY Upstate Medical University: (1) ART treatment-naive PWH; (2) age-matched HCs; and (3) ECs. Participants underwent brain MRI and clinical and neuropsychological assessments at baseline, 1 year, and 2 years. PWH were also assessed 12 weeks after initiating cART. Volumetric analysis and fractal dimensionality (FD) were calculated for cortical and subcortical regions. Mixed effect regressions examined the effect of group and imaging variables on cognition. We enrolled 47 PWH, 58 HCs, and 10 ECs. At baseline, PWH had worse cognition and lower cortical volumes than HCs. Cognition improved after initiation of cART and remained stable over time. Greater cortical thickness was associated with better cognition at baseline; greater FD of parietal, temporal, and occipital lobes was associated with better cognition at baseline and longitudinally. At baseline, ECs had worse cognition, lower cortical thickness, and lower FD in all 4 lobes and caudate than PWH and HCs. Greater cortical thickness, hippocampal volumes, and FD of frontal, temporal, and occipital lobes were associated with better cognition longitudinally. Initiation of cART in PWH is associated with improvement in brain structure and cognition. However, significant differences persist over time when compared with HCs. Similar trends in ECs suggest that results are due to HIV infection rather than treatment. Stronger associations between cognition and FD suggest this imaging metric may be a more sensitive marker of neuronal injury than cortical thickness and volumetric measures.

Abstract 70: Females With Acute Myocardial Infarction Are Still Undertreated

Objective: To identify differences in management and outcomes in males versus females with acute myocardial infarction(AMI) presenting to our institution. Methods: Retrospective analysis of patients between the ages of 18 to 89 years old presenting to SUNY Upstate Medical University with a diagnosis of AMI defined as either STEMI or NSTEMI from March 2021 to September 2021. Patients with diagnosis of demand ischemia were excluded. Results: From a total of 236 patients, 44.1% (104 out of 236) were females. The age in both groups was similar with mean of 63.64 (SD 14.5) years old in males and 66.36(SD 14.2). Only 53.8% (56 of 104) Females were admitted to intensive care level of service versus 72% (95 of 132) males (P 0.004 OR 0.264-0.781). Cardiac catheterizations were done more frequently in males than females 78.8% (104 of 132) and 67.3% (71 of 104) respectively (P0.047). Between patients who underwent cardiac catheterization 45.7% (33 of 70) females and 66.3% (69 of 104) males received PCI. More males had depressed left ventricular ejection fraction 50.8% (64 of 132) versus 32% (31 of 104) females. Although not statistically significant, 30-day mortality was more frequent in women 10.6% (11 of 104) compared to males 6.8% (9 of 132). Conclusions: Females with AMI where less likely to be admitted to the ICU or undergo cardiac catheterization. They had either similar or worse 30-day mortality, despite having lower rates of coronary disease requiring intervention. These findings support the fact that despite the efforts taken in the last several years, women with AMI are still being undertreated.

Jenna Lester: advancing diversity in dermatology

For as long as dermatologist Jenna C Lester can remember, her decision to follow a career in medicine was inspired by her mother Sharon Brangman, who is now Distinguished Service Professor and Chair of Geriatric Medicine at State University of New York Upstate Medical University, USA. “Principles of service and advocacy have always been a consistent thread for me”, Lester says. Her maternal grandmother was a nurse practitioner, who, Lester explains, “wanted to get this advanced degree to be able to have as much independence and impact as possible.

Posterior Nerve-Sparing Corpectomy With Ventral Cage Reconstruction for a Lumbar Burst Fracture: A Video Illustration: 2-Dimensional Operative Video.

*Albany Medical Center, Albany, New York, USA; ‡State University of New York Upstate Medical University, Syracuse, New York, USA Correspondence: Michael Galgano, MD, State University of New York Upstate Medical University, 614 Jacobsen Hall, 175 Elizabeth Blackwell St, Syracuse, NY 13210, USA. Email: [email protected]

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Feb 2022Editorial CommentThis article comments on the following:Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC) Joseph M. Jacob Joseph M. JacobJoseph M. Jacob Upstate Medical University, Syracuse, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002233.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 207(2), p. 300 Reference 1. : Clinical model of lifetime cost of treating bladder cancer and associated complications. Urology 2006; 68: 549. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologySep 23, 2021, 12:00:00 AMRanking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC) Volume 207Issue 2February 2022Page: 300-300 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph M. Jacob Upstate Medical University, Syracuse, New York More articles by this author Expand All Advertisement PDF DownloadLoading ...

Compulsively Moral: OCD, Ethics, and the Law.

Compulsively Moral: OCD, Ethics, and the Law.

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

Editorial introductions.

Editorial introductions.

Ethical Issues in Caring for Older Adults.

Ethical Issues in Caring for Older Adults.

Not Even Pandemic Can Stop APA’s Popular MindGames!

Back to table of contents Previous article Next article APA & MeetingsFull AccessNot Even Pandemic Can Stop APA’s Popular MindGames!Search for more papers by this authorPublished Online:24 Jun 2021https://doi.org/10.1176/appi.pn.2021.7.48AbstractResidents from the University of Texas Health San Antonio won this year’s MindGames, the popular Jeopardy-like APA competition pitting residents from psychiatry programs across the country against each other to test their knowledge of patient care, medicine, and psychiatric history. The winning team members were (from left) Eric Parmon, M.D., Morgan Hardy, M.D., and Anna Zampese, M.D.The other teams were from Cooper Medical School of Rowan University and SUNY Upstate Medical University. Playing for Cooper Medical School were Garrett Rossi, M.D., Roshi DeSilva, D.O., and Michelle Mergenthal, M.D. Playing for SUNY Upstate were Mark Wiener, M.D., James Gilfert, M.D., and Sutanaya Pal, M.D.MindGames is traditionally held at APA’s Annual Meeting but this year had to be held virtually over Zoom.Art Walaszek, M.D., director of residency training at the University of Wisconsin, hosted this year’s event. Special judges were past APA President Michelle Riba, M.D., M.S., a clinical professor of psychiatry at the University of Michigan, and Philip Muskin, M.D., a professor of psychiatry at Columbia University Medical Center. ■ ISSUES NewArchived

Ethical Challenges in the Treatment of Anxiety.

Ethical Challenges in the Treatment of Anxiety.

Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study.

The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis. A retrospective chart review was conducted at 2 academic institutions, St Christopher's Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively. In the entire cohort of patients (N = 113, age range 0-123 months), 36% had otitis media with effusion on either history, physical examination, tympanometry, and/or imaging. Half (50%) of patients with coronal synostosis had otitis media with effusion compared to sagittal (40.7%), metopic (26.3%), multiple (25%), and lambdoid (0%). However, these differences were not statistically significant (P = .190). Most patients had normal hearing (91%), while a minority had either conductive (7%) or sensorineural (2%) hearing loss. The presence of otitis media in our cohort of patients with nonsyndromic craniosynostosis appears to be at the upper limit of normal when compared to historical rates in normocephalic children. Synostosis subtype did not appear to predict the presence of otitis media. Only 9% of patients with nonsyndromic craniosynostosis were found to have a hearing loss.

In Memoriam

In Memoriam

Incidence of Endophthalmitis, Then and Now

Purpose: Report the frequency of differing etiologies of endophthalmitis at the Upstate Medical University, and compare these results to previously reported data. Methods: A retrospective study was conducted based on the medical records of all patients diagnosed with endophthalmitis at the Upstate Medical University in Syracuse, New York between January 2014 to December 2019. Variables recorded included source of infection, microbial profiles, comorbidities, visual acuity and survival. Results: The study identified 62 patients who were diagnosed with endophthalmitis at the Upstate Medical University from January 2014 to December 2019. The most common etiology was endogenous endophthalmitis with 40 cases (64.5%), of these patients, 13 (32.5%) were culture positive. The remaining 22 cases (35.5%) were due to exogenous endophthalmitis. The mean age of patients with endogenous endophthalmitis was 51.4 years with 65.0% as male. The mean age of patients with exogenous endophthalmitis was 59.5 years with 59.1% as male. The most common identifiable risk factor associated with endogenous endophthalmitis was a history of intravenous drug use seen in 47.5%. Conclusion: Endogenous source was established as the most common etiology in patients diagnosed with endophthalmitis. These results, however, do not parallel with any of the previously reported data where endogenous etiology was identified as one of least common causes. The significance of demonstrating this increase in incidence of endogenous endophthalmitis is to illustrate a shift in paradigm and create awareness among ophthalmologists to avoid overlooking a possible life-threatening condition.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Didier A. MandelbrotDidier A. MandelbrotDr Mandelbrot is currently Medical Director of Kidney and Pancreas Transplantation at UW Health and Professor of Medicine at the University of Wisconsin School of Medicine. He was an undergraduate at Harvard College, medical student at the University of Pennsylvania, resident in Medicine at the Hospital of the University of Pennsylvania, and renal fellow at Brigham and Women's Hospital. He has a background in basic transplant immunology and a longstanding interest in the diagnosis and treatment of solid organ rejection. He has participated in numerous single and multi-center clinical trials in kidney transplantation, and has published almost 200 papers and chapters. He has made important contributions on the role of donor-specific antibodies in the context of kidney transplantation, pancreas transplantation and simultaneous liver-kidney transplantation. He also has a particular interest in living kidney donation, and has been active in describing and improving practices in the US. He was co-PI of the NIH-funded Kidney Donor Outcomes Cohort study and recently finished serving as Chair of the American Society of Transplantation's Living Donor Community of Practice. He is currently a member of the United Network of Organ Sharing Medical and Professional Standards Committee, the American Transplant Congress Program Planning Committee, and the Medical Board of the National Kidney Registry. He is an Associate Editor of Clinical Transplantation. Maria SiemionowMaria SiemionowDr Siemionow, a world-renowned scientist and microsurgeon, is Professor of Orthopedics and Director of Microsurgery Research at The University of Illinois at Chicago. She specializes in microsurgery, hand surgery, peripheral nerve surgery, transplantation, and microsurgery research. She is pioneering development of new technology for minimal immunosuppression in transplantation and enhancement of nerve and muscle regeneration. She served as a President of the American Society for Reconstructive Transplantation, President of the International Hand and Composite Tissue Allotransplantation Society and President of the American Society for Peripheral Nerve. She is a member of the academic-industry team, Warrior Restoration Consortium, focusing on development of clinical therapies and new technologies for wounded soldiers as part of the second phase of the Armed Forces Institute for Regenerative Medicine (AFIRM II). She has received numerous honors, including high praise as Principal Investigator for the world's first IRB approval for Facial Allograft Transplantation protocol; in 2008, she led the team that performed the first near-total face transplantation in the United States. Dr Siemionow has over 330 scientific publications. She has edited three plastic surgery textbooks, two popular science books, and has contributed to over 120 published book chapters. Dr Siemionow received numerous awards including the Polish Order of Merit (2009), the Commander's Cross Polonia Restituta Award from the President of Poland (2009), the Outstanding Achievement in Clinical Research Award from the Plastic Surgery Educational Foundation (2010); the 2011 American Society of Plastic Surgeons’ Board of Trustees Special Achievement Award and Casimir Funk National Science Award (2013). In 2014 she received the Great Immigrants Award from the Carnegie Foundation of New York. In 2016 Dr Siemionow was awarded the Heritage Award granted by the Polish American Congress. In 2019 she received Golden Otis Award. Prior to her UIC appointment, she was Director of Plastic Surgery Research and Head of Microsurgical Training for Cleveland Clinic's Department of Plastic Surgery. Jeffery A. KahnJeffery A. KahnDr Jeffrey A. Kahn completed his undergraduate training at the University at Albany, State University of New York, medical school training at the State University of New York, Upstate Medical University and internal medicine residency at Emory University. He then went on to fellowship training in gastroenterology at the University of Southern California and transplant hepatology training at Cedars Sinai-Sinai Medical Center. He has been the medical director of the Keck School of Medicine of USC Liver Transplant Program since 2011, with a special interest in living donor liver transplantation and transfusion-free liver transplantation. His research interests include liver transplant waitlist disparities, liver transplant outcomes and has ongoing translational research related to occult hepatitis C infection.

Trial in Progress: The Phase III, Randomized, Open-Label, Multicenter COMMODORE 1 Study Evaluating the Efficacy and Safety of Crovalimab Versus Eculizumab in Adult and Adolescent Patients with Paroxysmal Nocturnal Hemoglobinuria Currently Treated with Complement Inhibitors

Trial in Progress: The Phase III, Randomized, Open-Label, Multicenter COMMODORE 1 Study Evaluating the Efficacy and Safety of Crovalimab Versus Eculizumab in Adult and Adolescent Patients with Paroxysmal Nocturnal Hemoglobinuria Currently Treated with Complement Inhibitors

Trial in Progress: The Phase III, Randomized, Open-Label, Multicenter COMMODORE 2 Study Evaluating the Efficacy and Safety of Crovalimab Versus Eculizumab in Adult and Adolescent Patients with Paroxysmal Nocturnal Hemoglobinuria Not Previously Treated with Complement Inhibitors

Trial in Progress: The Phase III, Randomized, Open-Label, Multicenter COMMODORE 2 Study Evaluating the Efficacy and Safety of Crovalimab Versus Eculizumab in Adult and Adolescent Patients with Paroxysmal Nocturnal Hemoglobinuria Not Previously Treated with Complement Inhibitors

S0626 Implementation of an Acute GI Bleed Clinical Pathway in VA Hospital System

INTRODUCTION: Physician order entry (POE) has been integrated into many electronic health records for years. Syracuse VA Medical Center (VAMC) has been using POE; however, clinical pathways are underused or lack implementation. We are implementing an acute GI bleed clinical pathway at the Syracuse VAMC. Our aim is to assess if this implementation will reduce time to place orders, reduce errors and omission of appropriate orders. METHODS: Acute GI bleed pathway was created in CPRS EMR based on evidence based practices and in collaboration with Hospitalist, Gastroenterology, and Radiology departments at the Syracuse VAMC. Upstate Medical University medicine residents were observed admitting a simulated patient with acute GI bleed with known liver cirrhosis with and without using pathway. Clinical scenario of the simulated patient was created by hospitalist physicians. A check list for required orders (total 15) were made. Total residents involved were 40 (10 PGY1, 2 PGY2 and 8 PGY3 for the pre-clinical pathway group; 12 PGY1, 4 PGY2 and 4 PGY3 for the post-clinical pathway group). Primary outcome was number of orders missed and secondary outcome was time spent to complete orders. RESULTS: In the pre-clinical pathway group; average number of orders missed were 5.7 and average time to place orders was 5.55 minutes. Most common orders missed were telemetry, spontaneous bacterial peritonitis (SBP) prophylaxis and liver function test. In the post-clinical pathway group; average number of orders missed were 1.15 and average time to place orders was 5.39 minutes. Most common orders missed were telemetry, SBP prophylaxis and GI consult. Acute GI bleed clinical pathway significantly reduced the number of orders missed (P = 0.0004). There was no significant alteration in time spent to complete orders in both groups. CONCLUSION: Clinical pathways are strongly recommended in EMR systems as they were proven to decrease error and improve standardization of patient care. Some studies of order sets for specific conditions have shown reduction in mortality, length of stay, and readmission. We found that using clinical pathway for acute GI bleed reduces omission of appropriate orders. The time physicians spent placing orders was not significantly affected by the clinical pathways. To note, common missed orders in both groups were telemetry and SBP prophylaxis which may be related to lack of medical knowledge. This study may be helpful to facilitate using clinical pathways for other medical conditions at VA hospitals.Figure 1.: Number of orders missed with and without using acute GI bleed clinical pathway.Figure 2.: Time spent to complete orders with and without using acute GI bleed clinical pathway.

Aromatase Inhibitors Use for Endometriosis Patients

Shawky ZA Badawy1,2* and Jonathan D Franceschini1,2 Author Affiliations 1Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Upstate Medical University, USA 2Department of Clinical Pathology, Upstate Medical University, USA Received: August 14, 2020 | Published: August 26, 2020 Corresponding author: Shawky ZA Badawy, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Department of Clinical Pathology, Upstate Medical University, Syracuse, New York, USA DOI: 10.26717/BJSTR.2020.29.004854

The Impact of Obesity on COVID-19 Disease Severity.

Obesity has been declared a major risk factor for morbidity and mortality in COVID-19 patients. In this rapid review, we provide an overview of recently-published papers with clinical and epidemiological relevance on this topic. As part of a weekly COVID-19 data mining meeting, we conducted a literature review regarding the role of obesity in COVID-19 outcomes, particularly in young patients with COVID-19. We utilized the PubMed, Upstate Medical University Health Sciences Library, Google Scholar, and LitCovid databases to identify the articles. Our group identified seven relevant publications (four retrospective case series and three reviews). Our group's review of this topic illustrates that obesity is a common comorbidity in hospitalized COVID-19 patients. Obesity is associated with an increased likelihood of intermittent mandatory ventilation within the first 10 days of hospitalization and a higher risk of admission to acute or critical hospital care, including in patients aged less than 60 years, with one study showing it to be a greater risk factor than cardiovascular or pulmonary conditions for critical COVID-19 illness. There are some indications that moderate-intensity exercise may be beneficial for promoting a healthy immune system in patients with and without obesity. Given these findings, hospitals should ensure their staff are prepared and their facilities are adequately equipped to provide high-quality care to patients with obesity (PWO) hospitalized with COVID-19. Family medicine and primary care physicians are encouraged to counsel their PWO about their increased risk for morbidity and mortality during this pandemic.